Light Touch Inspections, Winterbourne View and the CQC

There was a report on the Community Care website on Friday that the CQC were ‘calling time’ on their so-called light touch inspection ‘regime’ thereby rolling out potentially to annual inspections for adult services and care homes.

As the article emphasises

Bower said that the CQC had favoured a “proportionate, risk-based, light-touch” approach to regulation – in which services were left uninspected for up to two years in the absence of issues coming to light – but service users, providers and staff favoured more inspections.

“What people want, particularly people who use services, is for us to put our boots on the ground,” she said. “Inspections are a really positive quality assurance for providers.”

It’s hard to believe Bower would have been saying this if she had not been forced into the position by the Winterbourne View scandal where substantial abuse was uncovered.

A shame that she did not show more backbone and spirit in protecting the organisation that was handed to her to lead when all the cuts were coming hard and fast. It did not take a genius to work out that the only reason the so-called ‘light touch’ system was implemented in the first place was to save money. The problem is, that it has stripped the CQC of any credibility it might have had as a regulator.

:: The managers did not ensure that major incidents were reported to the Care Quality Commission as required;

:: Planning and delivery of care did not meet people’s individual needs;

:: They did not have robust systems to assess and monitor the quality of services;

:: They did not identify, and manage, risks relating to the health, welfare and safety of patients;

:: They had not responded to or considered complaints and views of people about the service;

:: Investigations into the conduct of staff were not robust and had not safeguarded people;

:: They did not take reasonable steps to identify the possibility of abuse and prevent it before it occurred;

:: They did not respond appropriately to allegations of abuse;

:: They did not have arrangements in place to protect the people against unlawful or excessive use of restraint;

:: They did not operate effective recruitment procedures or take appropriate steps in relation to persons who were not fit to work in care settings;

:: They failed in their responsibilities to provide appropriate training and supervision to staff.

While there is no excuse for such considerable failures, you’d think that a good regulator worth it’s proverbial salt should have picked up some of these issues through a thorough and robust regulation system.

Remember this is the same Bower who has promoted extensively the use of whistleblowing and family members as a ‘resource’ to augment their inspection processes. And then the organisation feigns upset when things are concealed to it.

How did we come to this? How did we, as a society, allow the organisation that regulates Health and Social Care to be stripped bare due to a resource-led decision and blunt its teeth so incredibly that people who depend on these services can have no confidence in its position to protect?

Money, cost, closed eyes and an ability to discharge responsibility for the care of those in our society who need particular protection has led for this situation to emerge.

Unfortunately I can’t go into details about some of the things I have seen over the past week that makes me feel much more strongly about these issues but suffice to say this – which, in itself – could even be too much.

I visited a care home which had an ‘excellent’ star rating. Yes, the stars are outdated but it is an easy way to check and remains so. There had been no inspections over the past year, at least, anyway. Excellent. And it looked it on the outside. My involvement was due to a large scale safeguarding investigation. Let’s just say it was very far from excellent and had been for a number of years, including when the last ‘excellent’ inspection rating had been given.

The inspections depend too heavily on self-reported data and too little on ‘feet on the ground’ and investigations skills. I sometimes wish I could try doing a really thorough, wholesale inspection of any given inspection service. I’ve worked in residential care. I know what I would look for. It angers and upsets me that self-reporting and the ‘light-touch’ were ever permitted for purely cost-related reasons.

But the CQC says it is increasing inspections – still it will not be close to previous levels. To see them criticise Castlebeck – all well and good – but it doesn’t take the responsibility for inspection and regulation away from them. It bears some resemblence to the social workers who are told they are more easily led by parents who conceal information from them. If the social workers are chastised for ‘believing’ why not the regulator.

It makes me angry. Maybe time to invest in regulation and inspection and demand better services that actually protect against, rather than mask poor care. It is ever more important.

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For some reason, managers in “social care” have colluded with the cost cutters, knowing full well what would happen. Why did they not speak up? Assume it was to keep their fairly well paid jobs! I suspect they justified this to themselves the same way News of the world journos justified phone hacking and other unpleasant practices. If they didnt do it they would loose their jobs. The culture within care needs looking at just as much as the culture witin newspapers.

Difficult to disagree with all of the above but as a health provider (rather than social care provider) I have reported safeguarding concerns and the the social team investigations were not as robust as the internal reviews. If we are going to regulate/investigate it must be done by skilled regulators (with teeth) and investigators without preconcieved outcomes and with transparency

Thanks CB. It really does beggar belief that the head of a regulatory body can state concerns that the organisations it inspects might not be fully candid in their dealing with the body and further, that they state this expecting it to be considered as a mitigating factor when considering the body’s own pathetic underperformance.

Self regulation didn’t work for the media and didn’t work for the banks. I don’t see how anyone could imagine it would work anywhere at all unless they were ideologically opposed to regulation as an interference in the operation of the market and wanted to garnish the arrangement with a tastefully placed fig leaf for the benefit of people who might be squeamish about leaving the most vulnerable people in society at the mercy of the market.

I think this issue would be higher up the news agenda if the papers weren’t full of the papers. Pity. Southern Cross and Winterbourne View might have provided the lever for change but the opportunity may exhaust itself with attention directed elsewhere.

Another good posting, on a hot topic that refuses to go away…. with strong parallels to recent policing problems – we didn’t proceed with the investigation as the suspects were uncooperative, is not too far away from bleating about Castlebeck not being entirely truthful in their reporting.
The inspection system has been travelling in this direction for some years and explains why commissioners have been designing and implementing their own QA systems so as to be clearer about the services they were using (though I do wonder how commissioners would account for their appalling lack of interest in people whom they had placed at Winterbourne View in order that they could be ‘assessed’).
A regulator that publishes a report, 7 weeks after a television programme, as a way of demonstrating that it is ‘in touch with the field’ is neither use nor ornament!
The recent statement by the CQC Chief Exec, outlining plans for more frequent inspections, is a barely disguised bid to justify the call for more resources. While we might all be sympathetic to having to inspect more services with fewer staff and less money this should not be allowed to obscure the decision – in principle, not a pragmatic response to reduced funding – to move to a ‘risk-based’, self assessment model that downgraded the importance of/need for inspectors to ever set foot in homes.

My own confidence in CQC evaporated some time ago. As a carer, it’s main impact on us has been to prevent one of our service providers from continuing to provide part of our sons care for administrative reasons – nothing to do with safeguarding – simply a result of the changes to registration rules that used to prevail under CSCI.
Result is a gap in care provision that we as informal carers have to pick up – for no cost of course and to the detriment of our sons quality of life. CQC seem far more interested in ‘checklisting’ than in the actual quality care in the real world.

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